Commonwealth of Virginia State Board of Health
Organization Active NPI Public Health or Welfare Agency · Fincastle, VA
NPI 1104879568 · NPPES record last updated Jul 20, 2012
Key facts
- NPI
- 1104879568
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Public Health or Welfare Agency 251K00000X
- Legal business name
- COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
- Practice address
- 21 Academy Street
Fincastle, VA 24090-0220 - Phone
- (540) 473-8240
- Fax
- (540) 473-8242
- NPI assigned
- May 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Vivian Penn-Timity
- Title
- Business Manager
- Phone
- (540) 204-9718
Corporate family (same tax ID) 24
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031117000414 | VA | Part B Supplier - Public Health/Welfare Agency | 0547174369 |
Receives reassigned benefits from 6 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Commonwealth of VA State
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | Yes |
Addresses
Primary practice location
21 Academy Street
Fincastle, VA 24090-0220
Mailing address
PO Box 220
Fincastle, VA 24090-0220
Phone (540) 473-8240
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4975324 | Medicaid | VA |
Other names
- Botetourt County Health Department
Other providers in Fincastle, VA
- Kenna Noel Blankenship
- Botetourt County Board of Supervisors
- Botetourt County Public Schools
- Sandra Brinkley
- Robert G Collins
- Tiffany Yvette Curry
- Fincastle Drugs and Sundries Inc.
- Stephen Lee Forbes
- Kenneth George Jr.
- Brian Huwe
All providers in Fincastle, VA · Public Health or Welfare Agency in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.